As a midwife, I face the enormous and important task of educating women and families on pregnancy, birth and the early days of parenting.
Because a woman’s care is often fragmented and she may see a different midwife or care provider at every appointment, it is very difficult to ensure we are providing all the information and knowledge that a mother is deserved so she can make informed decisions throughout her care.
A study in 2010, ‘Queensland Centre for Mothers and Babies: Having a Baby in Queensland', states that in their study of over 3500 women, 70% of women who had an epidural felt uninformed or did not provide consent to the procedure. They also stated 26% of women had not been informed or consented to their episiotomies. As midwives, how can we better ensure women are involved in their care and informed appropriately?
I have worked in several models of care, and in my experience, the model of care that can provide the most thorough and informative education, and therefore true informed consent from women, is that of a model where there is continuity such as a midwifery group practice or through a private midwife (look out for our radio podcast all about Privately Practising Midwives in August).
When we work in a model of care where there is not continuity, as midwives, we must really make sure that the women we see receive all the information they need and are actively involved in their care. We must know that the decisions they make are based on INFORMED consent. We have a responsibility and duty of care to keep women and babies safe, and they have a right to be respected and not coerced in their decisions.
Sometimes women make an informed decision that goes against routine or recommended care- they may decline a routine blood test or ultrasound, or decline administration of antibiotics for GBS. We must make sure we find out why she declines, as a woman declining electronic fetal monitoring in labour, may not be opposed to monitoring, but she may be concerned about mobility in labour. We can better understand her needs by asking questions and respecting her right to make her own decisions.
Top photo by Brandi Redd on Unsplash.
I am a midwife and I am a mother to a delightful little toddler.
For the last 6 years I have worked in various locations as a midwife, and informed consent has been an important part of my practice. It is a woman’s right to have autonomy over her body and her baby at all times, and I am legally obliged to discuss the benefits and risks of any procedures or treatments with the women I care for. As a midwife, informed consent is about providing information, offering alternatives, encouraging questions and working together with a woman about her decisions and care.
I knew that becoming a mother would involve a lot of decisions; decisions that I have helped many women make in my years as a midwife. It felt very different to be on the other side of decision-making, rather than on the side of providing information and knowledge. As a mother, Informed consent involved knowing my rights, gathering the information, understanding this information and giving my permission for something to happen, before it happens.
During my pregnancy, I was fortunate to be accepted into a low risk birthing centre for continuous care by a known midwife. This enabled me to develop a trusting relationship with my midwife, and feel safe and supported in the decisions I would make for myself and my baby. I also trusted in the knowledge she shared and that with many months of mutual discussions, she would know how to support me and my choices when it came time to labour and birth.
Informed consent in my pregnancy involved asking lots of questions and seeking further education. It involved plenty of listening and lots of reading. Some of the decisions I needed to make could be made based on the knowledge I already had as a midwife, but the knowledge and decisions were now a lot more important because they also involved my unborn baby.
Something that helped me in decision-making, and something that I offer all women is the BRAINS anagram. This is a valuable tool to have when confronted with an important decision, and can guide you in your discussions with your partner and/or care provider.
B- Benefits: What are the benefits to this procedure/test?
R- Risks: What are the risks associated with this procedure/test?
A- Alternatives: What are the alternatives to this procedure/test?
I- Intuition: What does your intuition tell you? Does the information make sense?
N- Nothing: What if we do nothing/decline this procedure/test?
S- ‘Scuse me: Take some time to discuss your options and make your decision. S can also suggest the need for a second opinion if you require.
By 42 weeks pregnant, my baby had not arrived yet, and my care was handed over to a larger hospital, now without my known midwife by my side. I was armed with my birth plan, outlining my preferences. I was fortunate that a lovely doctor and colleague of mine was on call that night and he took the time to talk through the decisions we needed to make, many of which I had not expected to make in my birth story. I felt educated when I provided consent to procedures, and felt supported in the decisions I made where I declined consent. My baby was born after a long and challenging labour, but I felt empowered because I knew I had educated myself, made important and informed decisions and because I felt respected in the choices I made.
I was the key decision maker in my story.
If you have recently birthed, did you feel you were given adequate information from our care giver so you could make the best decisions for you and your family? Or were you rushed into making decisions that you now feel unsure of? We would love to hear from you at firstname.lastname@example.org.
If you would like to read more about informed consent and your rights, check out these links fromHumanRightsinChildbirth.org, MyBodyMyBaby.com.au, Birthrights.org.uk. And we discuss consent in this podcast: As Long as the Baby is Healthy Part 1
(Photo by Jason Blackeye and Unsplash)
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